Provider Demographics
NPI:1972340586
Name:TAITANO, CASEY V
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:V
Last Name:TAITANO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CITRONICA LN APT 217
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1558
Mailing Address - Country:US
Mailing Address - Phone:619-609-1809
Mailing Address - Fax:
Practice Address - Street 1:746 ADA ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2693
Practice Address - Country:US
Practice Address - Phone:800-640-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker